The business case for adult disability care coordination.

DESIGN

The study used a retrospective pretest, posttest design of 245 beneficiaries. Physical impairment ranged from slight to severe.

SETTING

Minnesota Disability Health Options (MnDHO), a capitated Medicaid program.

PARTICIPANTS

Medicaid beneficiaries ages 18 to 64 with physical disabilities arising from multiple sclerosis, cerebral palsy, spinal cord injury, or brain injury.

INTERVENTIONS

Not applicable.

MAIN OUTCOMES MEASURES

Change in expenditures, rate of return, and utilization.

RESULTS

Mean MnDHO monthly expenditures including care coordination increased by a factor of 1.75 (P<.001) over the previous expenditures. Increasing age has a multiplier effect on increased expenditures. Hospitalization rates were unchanged, but the average cost per admission and average length of stay dropped significantly (P=.017, P=.032, respectively). For people enrolled at least 3 years, annual reductions in medical costs more than paid for the added cost of care coordination, but the savings in Year 3 were about 20% of the savings in the first 2 years.

CONCLUSIONS

Care coordination leads to higher program expenditures for enrollees with moderate physical impairments who encounter access problems, but has little impact on enrollees who are already getting 24-hour care. There is some evidence of adverse selection bias. MnDHO's disability care coordination may not be financially sustainable over the long term.